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REID v. AETNA LIFE INSURANCE CO.

October 12, 2005.

ARTHUR REID, Plaintiff,
v.
AETNA LIFE INSURANCE CO., Defendants.



The opinion of the court was delivered by: COLLEEN McMAHON, District Judge

DECISION AND ORDER GRANTING DEFENDANT'S MOTION FOR SUMMARY JUDGMENT AND DENYING PLAINTIFF'S CROSS-MOTION
Introduction
Plaintiff, a computer programmer analyst at a computer consulting firm, became unable to work and went on long-term disability in February 2000, after complaining of chest pains and blackouts brought on by work-related stress. Plaintiff was subsequently diagnosed with arterial clogging in his chest and legs and spinal compression, leading to pain symptoms in his knees, legs, and lower back. At the same time, Plaintiff underwent treatment for depression, memory loss and lowered cognitive functions, and symptoms of rage and anger.

The terms of the Plaintiff's long-term disability insurance plan stated that benefits for disability caused "to any extent" by mental or nervous causes would be terminated after twenty-four months. Defendant, pursuant to that plan, terminated benefits in February, 2002. Plaintiff sought and received a reconsideration of the termination; a final decision upholding termination was made in May 2002.

  Plaintiff brought suit under 29 U.S.C. § 1132, which enables civil actions for the enforcement of rights under an employee benefit plan covered by the Employee Retirement Income Security Act (ERISA). Upon submission of the administrative record and affidavits by both sides, Defendant moved for summary judgment. Plaintiff opposed and cross-moved for summary judgment as well.

  For the reasons stated below, the Defendant's motion is GRANTED and Plaintiff's cross-motion is DENIED.

  Facts

  Plaintiff was employed as a computer programmer analyst and project manager at GRC International, a Virginia-based corporation which provides technical consulting services to the Department of Defense and other government agencies. AReid01313. Prior to his employment at GRC in February, 1997, Plaintiff had twenty-two years of experience as a programmer at IBM. Plaintiff's Opposition to Defendant's Motion for Summary Judgment and In Support of Cross-Motion for Summary Judgment (hereinafter, "Opposition") at 2. His work as a programmer analyst at GRC was described as 95% sedentary, with no lifting or pulling, and no exposure to dangerous materials. AReid01310. Prior to 1997, Plaintiff was relatively athletic and active, engaging in running, recreational basketball, and other activities. Areid00253. At the same time, he smoked two or more packs of cigarettes a day, had not had a physical examination in fifteen years, and appeared obese. Id. Through GRC, Plaintiff was covered by a Group Life and Accident and Health Insurance Policy ("the Plan"), which included long-term disability coverage, provided by Aetna Life Insurance Co. (hereinafter, "Defendant"). See Affidavit of Maria Piotrowski (hereinafter, "Affidavit") at ¶ 2 . The Plan is an "employee benefit plan" under the terms of the Employee Retirement Income Security Act (ERISA). 29 U.S.C. § 1101(a) (2000). Disability for purposes of the Plan is defined as an incapacity, "solely because of injury or disease, to perform the material duties of your own occupation" for 36 months after the time of injury. Areid01641. After thirty-six months, a claimant must be shown to be unable to work in any reasonable occupation, solely due to illness or disease, to continue receiving benefits. Id. AReid01634,01642. However, long-term disability benefits could be terminated after twenty-four months if the disability is at that time caused to any extent by a mental condition.*fn1 AReid01642-01643.

  The Plaintiff's medical history, largely undisputed, is as follows. In May 1997, Plaintiff first complained of pain in both legs brought on by extensive walking or playing basketball. Areid00262. This pain did not limit his range of joint motion. Id. He was referred to Dr. Louise Reynolds of Vienna Family Medicine, who diagnosed him as having claudication — a reduced flow of blood to the legs caused by arterial clogging. The patient attempted chelation treatment — ingestion of the chemical EDTA to increase blood flow without surgery.*fn2 Areid00253. In addition, he was diagnosed with high cholesterol and non-insulin dependent diabetes mellitus, which he sought to control with prescription medications. Id. Furthermore, Dr. Reynolds issued the Plaintiff a prescription for a nicotine patch to control his cigarette addiction. Id.

  Initially, the Plaintiff did not fully cooperate with his medication regimen. Areid002490-0252. He did not begin to use the patch, "intermittently" took medication for cholesterol, and possibly ceased taking the prescribed diabetes medication. Areid00248. By late 1998, although the initial symptoms of leg pain had decreased, he reported new pain in the ball of his left foot. AReid00245. He treated the pain with prescription ibuprofen. Areid00242. In mid-1999, the symptoms of foot pain apparently re-appeared, and were re-treated with ibuprofen by a Dr. Cecil. Areid00242 There is no record of the Plaintiff's raising his prior issues of high cholesterol or diabetes at this visit. Id.

  In late 1999, Plaintiff, now a GRC project manager, was asked to terminate two individuals under his employ as a cost-cutting measure, a request which apparently caused him a significant amount of stress and confusion. Areid00889. In October, he began to suffer from chest pains, burning sensations in his left arm, and numbness. AReid00240. On November 8, 1999, after Plaintiff had fired one employee, GRC notified him that he would also be let go. Areid00889. That event triggered increased chest pain and an intense blackout; he was admitted to the emergency room at Fairfax Inova Hospital complaining of chest pain, numbness, and tenderness in the rib cage. Areid00379. A thallium scan detected possible inferior ischemia — reduced blood flow to the heart. Id. Further analysis based on a November 11th catheterization probe of his chest detected significant plaque in the left coronary system, and a possible lesion in the right coronary artery. Areid01236. The Plaintiff opted in favor of non-invasive treatment rather than an angioplasty at this time. Areid01237. As a result of his hospitalization, Plaintiff came under the care of Dr. Kerry Prewitt for care of the pain in his legs. His initial report notes that Plaintiff was still unable to walk more than one or two blocks before onset of pain. Areid00075. On January 14 and 21, 2000, successive femoral angioplasties were performed on the Plaintiff's right and left legs to address the reduced blood flow. Areid00114. The therapeutic effect of the angioplasties was limited — Plaintiff returned with complaints of pain in his legs and left foot almost immediately afterwards. Areid00112. Dr. Prewitt, at that time, concluded that the new symptoms were not the product of claudication. Id.

  Plaintiff subsequently sought treatment from Dr. Bruce Smith, who evaluated the Plaintiff and diagnosed a herniated disk in his back and compression of the spine. Areid00154. This finding was confirmed by a September 18, 2000, MRI, which detected disk herniation and mild stenosis — painful pressure on the spinal nerves by vertebrae. Areid00160. Dr. Smith also noted how Plaintiff's ongoing depression constituted a risk factor and could affect his ability to interact with physicians. Areid00154. At this point, Plaintiff agreed to wait before moving to consultation with an orthopedic surgeon. Id.

  In a June 2000 letter, Dr. Prewitt indicated that the Plaintiff's leg pain had spread, and now occurred while Plaintiff was immobile. Areid00162. He also noted Plaintiff's unease with the length of time the visit required, difficulty in remembering drug dosages and prior diagnoses, and interest in chelation therapy rather than repeated angiograms or angioplasties. Id.

  By August, 2000, Plaintiff had come under the care of Dr. James Melisi, a neurosurgeon. Dr. Melisi's complete file is not included in the record provided. Opposition at 7. It appears, however, that in May 2001, Dr. Melisi scheduled Plaintiff for a laminectomy — surgery on the vertebrae to remove pressure on the spinal nerves. Areid00063. This operation was aborted after a pre-operative screening detected Plaintiff's blood sugar level at over 600. Id. A pre-operative report, dated May 7, 2000, by Dr. Harvey Sherber, notes normal electrocardiogram results and some walking ability. AReid00055-00058. Dr. Sherber also noted concern for Plaintiff's long-term cardiovascular health. The laminectomy was successfully performed two months later, and post-operative MRIs indicated a clean prognosis and no need for additional spinal surgery. Areid00597.

  Beginning in April 2001, Plaintiff complained of new pain in his knee joints. He was referred to Dr. Christopher Annunziato, who treated him with lidocaine injections in late April, 2001. Areid00743. When these injections did not arrest the Plaintiff's symptoms, he opted to undergo arthroscopic surgery on his right knee on August 20, 2001. Areid00738. Similar surgery was planned for the left knee, although never completed. Opposition at 9.

  The arthroscopic surgery apparently had minimal impact on the Plaintiff's pain symptoms. In his last patient report, Dr. Annunziata observed continued pain, although also noted a range of knee movement of up to 120 degrees. Areid00734. Plaintiff entered physical therapy at Phyllis Moriarty & Associates in January, 2002. His initial consultation showed intense lower back and rear pain, limited leaning ability, and difficulty sleeping on his back. Areid00674. Although it is not clear how long he attended physical therapy, records indicate approximately a month of constant attendance. Areid00677-00678. He subsequently began treatment with Dr. Michael Vierio, a chiropractor, on February 11, 2002. Opposition at ...


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